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Abstract Introduction Inadequate sleep hygiene (SH) is considered factor contributing to insomnia. However, the practice of SH by depressed patients with comorbid insomnia has not been explored. Objective We aimed to compare the practice of SH between patients with major depression, comorbid insomnia, primary insomnia, and good sleepers. Method One hundred and eighty-two adult individuals participated: 62 outpatients with major depressive disorder with comorbid insomnia (MDD), 56 outpatients with primary insomnia (PI), and 64 good sleepers (GS). All participants were assessed with a structured psychiatric interview, an insomnia interview, the Pittsburgh Sleep Quality Index, the Insomnia Severity Index, and the Sleep Hygiene Practice Scale. We compared the practice of SH as a whole and by domains between the groups and the relation between SH practice, insomnia, and sleep quality. Results Patients with PI and MDD showed a significantly worse practice of global SH. In the comparison by SH domains, MDD and PI groups had significantly worse scores than GS in all domains. Individuals with MDD showed a significantly worse practice of sleep schedule and arousal related behaviors than PI group. Although, SH practice was significantly related with insomnia and sleep quality in the whole sample, this association remained significant only in the PI. The arousal-related behaviors domain was the main predictor of insomnia and sleep quality. Discussion and conclusion Although patients with insomnia comorbid with MDD or with PI have a worse SH practice than GS, only arousal-related behaviors and drinking/eating habits contribute significantly to insomnia severity and sleep quality.
Resumen Introducción Una inadecuada higiene de sueño (HS) se considera como un factor que contribuye al insomnio, incluido el insomnio comórbido con trastornos mentales. Sin embargo, no se ha estudiado la práctica de HS en pacientes con depresión e insomnio comórbido. Objetivo Comparar la práctica de HS entre pacientes con depresión mayor con insomnio comórbido, insomnio primario y buenos durmientes. Método Participaron 182 individuos: 62 pacientes ambulatorios con trastorno depresivo mayor con insomnio comórbido (TDM), 56 pacientes con insomnio primario (IP) y 64 buenos durmientes (BD). A todos se les realizó una entrevista psiquiátrica estructurada, una entrevista sobre insomnio, el Índice de Calidad de Sueño de Pittsburgh, el Índice de Severidad de Insomnio y la Escala de Prácticas de Higiene de Sueño. Comparamos la práctica de HS tanto global como por dominios entre los grupos, y la relación entre la práctica de HS, el insomnio y la calidad de sueño. Resultados Los pacientes con IP y con TDM mostraron una práctica global de la HS significativamente peor. En la comparación por dominios, los grupos con TDM e IP alcanzaron peores calificaciones que los BD en todos. La práctica de HS se relacionó significativamente con el insomnio y calidad de sueño en la muestra total, sin embargo, solamente en el grupo con IP se mantuvo significativa. El dominio de conductas relacionadas con el alertamiento fue el principal predictor de insomnio y calidad de sueño. Discusión y conclusión Aunque los pacientes con insomnio comórbido con TDM o con IP tienen peores hábitos de HS que los BD, solamente las conductas relacionadas con el alertamiento y los hábitos de alimentación contribuyen significativamente a la gravedad del insomnio y calidad de sueño.
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Parkinson's disease (PD) is not a single entity but rather a heterogeneous neurodegenerative disorder. The present study aims to conduct a critical systematic review of the literature to describe the main pharmacological strategies to treat cognitive dysfunction and major depressive disorder in PD patients. We performed a search of articles cited in PubMed from 2004 to 2014 using the following MeSH terms (Medical subject headings) "Parkinson disease"; "Delirium," "Dementia," "Amnestic," "Cognitive disorders," and "Parkinson disease"; "depression," "major depressive disorder," "drug therapy." We found a total of 71 studies related to pharmacological treatment in cognitive dysfunction and 279 studies for pharmacological treatment in major depressive disorder. After fulfillment of all the inclusion and exclusion criteria, 13 articles remained for cognitive dysfunction and 11 for major depressive disorder, which are presented and discussed in this study. Further research into non-motor symptoms of PD may provide insights into mechanisms of neurodegeneration, and provide better quality of life by using rational drugs.
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INTRODUCTION: The Epworth sleepiness scale (ESS) is a widely used instrument in the subjective assessment of sleepiness. Although there are several translations into Spanish, their equivalence to the original version is questionable. OBJECTIVE: To assess the reliability and validity of a true translation into Spanish of the ESS in Mexican population. METHOD: The ESS was translated into Spanish with the use of standard translation methodology: forward translation, back translation and bilingual committee consensus. It was administered to six groups of subjects of the following categories: narcolepsy, obstructive sleep apnea syndrome (OSAS), major depression with OSAS risk, major depression without OSAS risk, good sleepers and insomniac patients without OSAS risk. Internal consistency and factorial structure of the ESS was estimated. In addition, a comparison between groups of the ESS scores was conducted. RESULTS: The ESS showed to be composed by only one factor and it also showed a high reliability coefficient (0.89). Likewise patients with narcolepsy or OSAS had the highest scores while good sleepers obtained the lowest scores. CONCLUSION: The true translation into Spanish of the ESS showed similar psychometric properties to the original version and, superior to previous Spanish adaptations. Therefore, the ESS is a reliable instrument for the assessment of sleepiness in our population.